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NPI Code Detail

MEDICARE: 4401 HAVERFORD AVENUE OPCO LLC

MEDICARE: 4401 HAVERFORD AVENUE OPCO LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1790565554
Entity Type Code : Organization
Provider Name (Legal Business Name) : 4401 HAVERFORD AVENUE OPCO LLC
Provider Business Mailing Address
First Line : 1105 E COUNTY LINE RD STE 201
Second Line :
City : LAKEWOOD
State : NJ
Zip : 08701-2178
Country : US
Telephone Number : 732-592-2205
Fax Number :
Provider Business Practice Location Address
First Line : 4401 HAVERFORD AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19104-1332
Country : US
Telephone Number : 732-592-2205
Fax Number :
Authorized Official
Title or Position : CEO
Name : BENJAMIN KURLAND
Credential :
Telephone Number : 732-592-2205
Provider Enumeration Date : 09/29/2023
Last Update Date : 12/30/2025

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